13064 - Laserfiche WebLink

Home Browse Search

SJR OFFIc US r APPLICATION FOR SANITATION PERMIT Permit No. ._� -;-.- --------------- ----------------------------------------- (Complete in Duplicate) ------------------------------_-------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATI N... & .�.- - ------------------------ --•-----------------..------. Owner's Name----- � .......4, -------------`-------- - Phone......................------•------- Address-------........_��,t! +�+- �------------------------------------------•------------••-------- .................... I Contractor's Name----- _ -'— Phone I Installation will serve: Residence 9?'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms j?.- Number of baths _/_. Lot size ' /�� .�J__________________________ ' Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table },Kfft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RRO<arclpan ❑ Previous Application Made: [If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-------------.Distance glom foundation___�e------MaTal-__( �f��_________._. [� No. of compartments------�--------------Sizet-,K---X_ _-_--Liquid depth--�P____-__------Capacity.. ,��.------- Disp�os,/al Field: Distance from nearest well-------_-Distance from foundation__ __ ....._._. �� `� Distance to nearest log line__W;,0 ltd' Number of lines----._ -___ __ Length of each line------ `___:__._Width of trench___Z_ _______________________ i ------ ---- - Type of filter material_ Depth of filter material_�� _________Total length 'P..................... .___ �' nce from fo ndation__/0----..___.Distance to nearest lot line_��___-- Seepage �t Distance ptares�well ^"9 mDteaa p_�}�----Size: Diameter.��r_ p oi*r - ---- fsd`mss \ , -------.De th_ f X�- V Cesspool: Distance from nearest-well-----------------Distance from foundation--------------------Lining material____._._____________._--__-_.___-- ❑ Size: Diameter--------------------------------------Depth_---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _______--___.__!__________________-------------Distance from nearest building--------._-_.--_-____________.___.____._. ❑ Distance to nearest lot line: -------------------------------------- ----------------------------------------- ------ Remodeling and/or repairing {describe):-------- 9 ------------------------------------------------------------------•--- -•------•--------------------•---------------------------•---•----•-•------------------------------------------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regu ations of the San Joaquin Local Health District. (Signed)----------------- ---:-------- ---- - --- -------- --- - ------------------------ (� Con#rector) BY= :. - "� ----------•--(Title)---- \ /�(�4_< - -------------- (Plot plan, showing size of lot, location of system ' ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --------------------------------- DATE------ 2-,1-6--1-------- ------------------------- REVIEWEDBY------------------------------------------ -- -------------------- ------------------------------ ---------------------------- DATE---------------------------------------------------•------- BUILDINGPERMIT ISSUED-------_--------- -----------------------------------------—------------------------------------_ DATE------------------------------------------------ ------------ Alterations and/or recommendations----------=--==- _- ----------------------------------------•------=---------------------.----------------•---•-----• -•------•------------------------- ---------- ---------- ••-•--_------------ ....... ------------------ ----------------------------------------- ---- -------------------- r ---------------------------------- -- ----- ------------------r--------------------------------------------------------------------- ------•-•- ------------------------------------------------------------------------------ FINAL INSPECTION Date-_-- �-------------------------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,CaIIfornla Lodi,California Manteca,California Tracy,California 6JR-9 RrViBr7 8.89 r.P.Ca.2M 6-67'